1. Medicare ABCs

2. What Is Medicare?
Federal health insurance created in (amendment to Social Security Act)
You must be U.S. citizen or legal permanent resident and
65 or older
Under 65 and disabled 24+ months on Social Security Disability
End-Stage Renal Disease
(any age)
A FEMALE
HOSPITAL (PART A) MEDICAL (PART B)
Jane Doe

3. Components of Medicare
Part A Hospital
Part B Medical
Supplement
Part D Drugs
Part C Medicare Advantage OR

4. Part A (Hospital) Part B (Medical) Hospital as Inpatient
Skilled nursing facility
Home health care
Hospice
Part B (Medical)
Doctor services
Hospital as Outpatient/Observation
Emergency room
Durable medical equipment
Other supplies and services

5. Hospital Status affects what is covered by Part A or B and whether subsequent Skilled Nursing Facility (SNF) is covered.
Inpatient – When you’re formally admitted with a doctor’s order. The day before you're discharged is your last inpatient day.
SNF covered IF:
Inpatient 3 midnights,
Admitted to SNF w/in 30 days, Care needed for hospital-treated condition.
Outpatient – When the doctor hasn’t written an order to admit you, even if you spend the night.
Medicare Outpatient Observation Notice (MOON) – provided when in observation status longer than 24 hours, but before 36th hour

6. Parts A and B do NOT cover
Most prescription drugs
Routine dental, vision, hearing, and foot care
Long-term care (nursing home custodial care)
Non-emergency ambulance
Alternative medicine
Elective cosmetic surgery
Personal care
Health care outside the U.S (except emergency)

7. Part D covers Part D does NOT cover Prescription drugs
Brand name and generic drugs
Part D does NOT cover
Non-prescription drugs
Most vitamins and minerals
Weight gain or loss
Fertility
Cough or cold
Hair growth or cosmetics
Sexual or erectile dysfunction

8. So how much does it COST?

9. Part A costs
If you or your spouse paid FICA taxes for at least 40 quarters (10 total years), you pay no premium for Part A
99% pay no premium (can cost up to $422/month)
Everyone pays Part A deductible and co-pays
2018 benefit period deductible = $1340
Co-pays based on number of days in hospital

10. New-to-Medicare in 2018 pay $134 per month
Part B costs
New-to-Medicare in 2018 pay $134 per month
(low income get help /high income pay extra)
(if drawing SS, any increase is capped at COLA)
Everyone pays Part B deductible and co-pays
2018 Annual deductible = $183
Co-pays = 20% of most medical services

11. Medicare Savings programs
Federal and state-funded help with Medicare costs (premiums, deductibles, co-pays)
Low income/asset tests (home & car exempt)
Not only Medicaid level (Extra Help, QI1)
For more information: DHHS, Social Security, SHIIP, or local Area Agency on Aging

12. Income Related Monthly Amount Adjustment (IRMAA) –You pay in 2018 --based on 2016 return
Individual tax return
Joint tax return
IRMAA
Part B premium
$85,000 or less
$170,000 or less
$0.00
$134.00
Above $85,000
up to $107,000
Above $170,000
up to $214,000
53.50
$187.50
Above $107,000
up to $133,500
Above $214,000
up to $267,000
133.90
$267.90
Above $133,500
up to $160,000
Above $267,000
up to $320,000
214.30
$348.30
Above $160,000
Above $320,000
294.60
$428.60

13. Part D Costs Premiums range from $20.40 to $100.60 per month
(low income get help /high income pay Part D IRMAA)
Deductible and co-pays at pharmacy counter
Deductibles = $0 to $405
Co-pays = 5% to 44% of
full cost of drug, depending on
your total annual drug costs

15. Cap Your Medicare Costs
Medicare Parts A and B pay about 80% no cap on your co-pays of about 20%

16. Cap Your Medicare Costs
Two choices for insuring Parts A and B co-pays
Option 1: Medicare Supplement (Medigap) and Part D policies (front-end loaded)
Option 2: Part C - Medicare Advantage plan (back-end loaded)

17. Medicare Supplements
Supplements help pay A & B co-pays, depending on plan you choose
Buy Supplement from private company
6 months from Part B effective date, have one-time “guaranteed issue” right with no medical underwriting
Think long term, don’t just shop for price

18. Medicare Supplements
Supplements have front-end premiums, but low out-of-pocket when using medical services
10 Standardized plans available in Nebraska
2018 Monthly non-tobacco premium range for Plan G
$91--$226 per month (female)
$ (male)

20. Part D Plans
Plans help pay prescription drug costs, depending on plan you choose
Buy Part D plan from private company
Initial enrollment when you start Medicare
Each year open enrollment October 15 – December 7
Good idea to review periodically
Think short term, do shop for price

21. Cap Your Medicare Costs
What is the ALTERNATIVE ?

22. Part C – Medicare Advantage Plans
Alternative way to cap your out-of-pocket costs
Sold by private insurance companies (they collect per capita from government)
Very different rules, restrictions and costs than Original Medicare (A + B + Supplement + D)
Wrap hospital, medical and (usually) drug coverage into single plan -- plans are not standardized
33% nationwide / 12% in Nebraska

23. Part C – medicare Advantage Plans
Advantage plans charge low premiums, but higher deductibles & co-pays than Supplements
Premiums $0 - $188 per month, in addition to Part B
You pay deductible or co-pay for every service
HMO/PPO networks of medical providers
Out-of-pocket limits (don’t apply if not in-network)
You must check with all providers to ensure in-network
Travel/residence restrictions (not sold in all NE counties)
(if out of region, may only cover emergency care)

24. When, where to enroll in Medicare?

25. agencies responsible for Medicare Enrollment, premiums & replacement cards Administration

26. Medicare Enrollment at 65
If you don’t have work insurance, enroll at age 65
If you delay enrollment to after age 65 and do NOT have work insurance, there are permanent late enrollment premium penalties

27. Working After Age 65
You can keep work insurance and delay Medicare without penalties (includes spouse who is on your work insurance or you on spouse’s work insurance)
If insurance is from your/spouse’s current employer of 20+ people
--Small employers can require taking 65
--Retiree health plans are not creditable coverage

28. Starting Medicare Apply for Parts A & B
If starting at 65, or local Social Security office (If drawing Social Security, card is sent to you automatically)
If working past 65 and have work insurance
--O.K. to have Part A at 65 (not w/HSA plan)
--Do NOT start Part B at 65 (preserve guaranteed issue for Supplement)
--Cannot apply online when stop working (need forms to prove you had creditable insurance)

29. Starting Medicare
2. Apply for Medicare Supplement policy through mail, phone, or agent/broker 3. Enroll in Part D medicare.gov, SHIIP, or Aging Partners for plan comparisons & enrollment

30. Medicare Information and Help
Counseling
Cost comparisons
Enrollment assistance
Aging Partners:
SHIIP:

31. Nebraska Department of Insurance
Nebraska’s state-wide program to educate older Nebraskans and people with disabilities about health insurance and health care fraud.
SHIIP provides presentations and maintains a counseling program for Nebraskans who request one-on-one assistance. Services are free and unbiased. All counseling sessions are completely confidential.
Call
Nebraska Department of Insurance